I attended the Clinical Breakout Session titled ‘Role of FMT in IBD’ chaired by Dr Jessica Allegretti. On the panel were Dr David Binion, Dr Alan Moss, and Dr Monika Fisher.
Fecal Microbiota Transplant, or FMT, is one of the emerging treatment options for IBD. It is considered as an effective treatment option for C.Difficile infections. As around the world, several clinical trials are underway in India as well. It can be an attractive option for patients in a country like India, where biological therapy is expensive and not covered by insurance. As a result, patient interest in FMT has increased considerably in recent times.
Although the session was not aimed at a patient audience, I absorbed a significant amount of information that can be useful for patients. Some of the key points to note as a patient were:
A C.Difficile infection (CDI) is very destabilising for someone with Inflammatory Bowel Disease (IBD). Even patients who have been in deep remission for years can suddenly experience flare-ups post a C.Difficile infection. Hence, it is of utmost important to treat the infection as early as possible in patients with IBD.
Patients with IBD have a 50% chance of recurrence of C. Difficile infection post-treatment with a 10-day Vancomycin course.
COVID has impacted the availability of FMT as a treatment.
IBD therapy may need to be ramped up post a CDI, but high-dose steroids should be avoided.
Diet can be considered in some regards as a prebiotic and influences the microbiome, which can have significant effects on the clinical course of a patient.
Patients with mild disease (ulcerative colitis specifically) benefit the most from FMT.
There is very little data to support the usage of FMT for the treatment of patients with Acute Severe ulcerative colitis.
For some patients with mild-to-moderate Crohn’s/colitis, FMT may be beneficial.
FMT is not yet FDA approved for the treatment of IBD in the absence of CDI. It has to be done in a clinical trial setting.
FMT can be done for patients with internal pouches as well. The success rate is almost the same as for IBD patients without a pouch.
Colonoscopic delivery of FMT seems to be more effective and provides the best results.
Retention of donor material can be an issue for patients. The therapy still works even if some material comes out.
Sometimes, patients can be sedated to take a small nap post the procedure to avoid loss of material.